Systems and methods for determining a position for placing of a joint prosthesis

ABSTRACT

Systems and methods for virtual implant placement to implement joint gap planning are discussed. For example, a method can include operations for receiving a first implant parameter set based on a surgical plan that was generated while moving the joint through a range of motion. The method can include generating a first set of candidate implant parameter sets that are the result of an incremental change, relative to the first implant parameter set, to at least one parameter of the first parameter set. The method can include calculating a result for at least one candidate implant parameter set and providing a graphical representation of the result according to at least one candidate implant parameter set. The result can be color-coded to correlate to a candidate implant parameter set. The display can include color-coded user interface controls to allow a user to execute incremental changes corresponding to candidate implant parameter sets.

RELATED APPLICATIONS

This Patent Application claims the benefit of priority to U.S.Provisional Patent Application Ser. No. 61/791,829, filed on Mar. 15,2013, which is hereby incorporated by reference herein in its entirety.

TECHNICAL FIELD

This application relates generally to computer-aided surgicalprocedures, and more specifically to systems and methods to providecomputer-aided placement planning for joint replacement implants.

BACKGROUND

In knee replacement surgery, a surgeon places a first prosthesis on thedistal end of the femur and a second prosthesis at the proximal end ofthe tibia. A surgeon should place the prostheses in an optimal way withrespect to various parameters, for example, with respect to the gapbetween the prostheses throughout a range of motion. For example, if thegap between the tibia and femur is too small at any time during motion,the patient can experience painful binding. On the other hand, if thegap is too large, the knee joint can be too loose and become unstable.

Determining an optimal position and orientation of these prostheses, orimplants, relative to the patient is difficult. Many factors must betaken into account—some quantitative, other qualitative. So called“surgical navigation” systems can help quantify certain plan parameterswith high accuracy, but it is still up to the surgeon to balance theseand other parameters, incrementally adjusting the plan often with asimple user interface. The user interface must be simple to use in theoperating room, and therefore all the ramifications of any particulardecision by the surgeon cannot be presentable easily without a complexinterface. Medical personnel can use the surgical navigation system'scomputer to optimize the quantitative parameters, though it cannot knowwhat the surgeon is thinking, and it cannot evaluate the qualitativeparameters. In addition, two or more potential surgical plans can beequivalent when evaluated per the qualitative metrics, but it wouldrequire a surgeon to choose between these alternatives in light of thequalitative factors. The mental task of predicting the outcome ofdesired changes to the plan that are available via the user interfacewith respect to both the qualitative and quantitative metrics is adifficult one.

In light of this challenge, there exists a general need to provide asurgeon with easy to evaluate predicted results of various actions, andto allow the surgeon to choose one or more actions that can result in animproved placement of the implant on one or both of a femur and a tibia.

BRIEF DESCRIPTION OF THE DRAWINGS

Some embodiments are illustrated by way of example and not limitation inthe figures of the accompanying drawings in which:

FIG. 1 is a block diagram depicting a system for providing joint gapplanning through virtual placement of a prosthetic implant, according toan example embodiment.

FIG. 2 illustrates an exemplary optical surgical navigation setupaccording to an example embodiment.

FIG. 3A is a diagram of a gap planning user interface, according to anexample embodiment.

FIG. 3B includes an enlarged depiction of a quadrant, gap curves, andgraph described regarding FIG. 3A according to an example embodiment.

FIG. 4 is a flowchart illustrating a method for gap planning, accordingto an example embodiment.

FIG. 5 is a diagrammatic representation of a machine in the example formof a computer system within which a set of instructions for causing themachine to perform any one or more of the methodologies discussed hereincan be executed.

DEFINITIONS

Implant—For the purposes of this specification and the associatedclaims, the term “implant” is used to refer to a prosthetic device orstructure manufactured to replace or enhance a biological structure. Forexample, in a knee replacement procedure an implant can be placed on oneor both of the tibia and the femur. While the term “implant” isgenerally considered to denote a man-made structure (as contrasted witha transplant), for the purposes of this specification an implant caninclude a biological tissue or material transplanted to replace orenhance a biological structure.

Implant host—For the purposes of this specification and the associatedclaims, the term “implant host” is used to refer to a patient. Incertain instances, the term implant host can refer, more specifically,to a particular joint or location of the intended implant within aparticular patient's anatomy. For example, in a knee replacementprocedure the implant host can refer to the knee joint of the patientbeing replaced, partially replaced, or repaired.

Real-time—For the purposes of this specification and the associatedclaims, the term “real-time” is used to refer to calculations oroperations performed on-the-fly as events occur or input is received bythe operable system. However, the use of the term “real-time” is notintended to preclude operations that cause some latency between inputand response, so long as the latency is an unintended consequenceinduced by the performance characteristics of the machine.

DETAILED DESCRIPTION

This disclosure describes example systems and methods of guiding asurgeon toward an optimal the placement of prosthetic implants relativeto the bones of a joint. In the following description, for purposes ofexplanation, numerous specific details are set forth in order to providea thorough understanding of example embodiments. It will be evident,however, to one skilled in the art, that embodiments can be practicedwithout these specific details.

When a surgeon places a prosthetic implant in a joint, the surgeon canplace one portion of an implant at a first bone in the joint and asecond portion of the implant at a second bone of the joint. Forexample, in the case of a knee prosthesis, the surgeon may place oneimplant at a tibia and a second implant at a femur. When placing theimplants, it is important to ensure a certain amount of gap between theimplants through a range of motion in the knee. An implant with toolittle of a gap can cause pain to the patient or can affect the fullrange of motion or operation of the joint after the implant is in place.However, if there is too much gap the joint may become unstable.

Accordingly, gap planning is important to ensure that there is neithertoo much nor too little gap between bones in the joint once theprosthetic implant is in place. Computer systems may provide automatedgap planning but fully-automated systems may prevent application ofhuman judgment to the implant planning process. Therefore, someembodiments provide a computer-aided gap-planning process that allows asurgeon to install virtual prosthetic implants at different positionsand to visualize the manner in which changes to placement of theprosthetic implants will cause changes to the gap between bones in thejoint.

FIG. 1 is a block diagram depicting a system 100 for providing joint gapplanning through virtual placement of a prosthetic implant, according toan example embodiment. In an example, a patient will lie on an operatingtable 105. A computer system 110 will provide a display for viewing dataprovided by optical trackers 120 and an infrared camera system 130. Theoptical trackers 120 and infrared camera system 130 can provide datarelevant to, for example, a knee joint. In an example, the infraredcameras system 130 can detect tracking spheres located on the opticaltrackers 120. Location data can be extracted from the images of theoptical trackers 120 to provide location data relative to the patientand more specifically the joint on which the procedure is to beperformed.

FIG. 2 illustrates an exemplary optical surgical navigation setup. Aninfrared camera 230 and optical tracker 220 can be used to performsurgical navigation. The optical trackers 120 can be rigidly attached toany object 240 that the surgeon wishes to track during the surgicalprocedure. The optical trackers 220 can serve functions of the opticaltrackers 120 (FIG. 1). The infrared camera 230 can serve functions ofthe infrared camera system 130 (FIG. 1).

The infrared camera 230 can take continuous images of the workspaceduring the surgical procedure, and the markers 225 are detected fromthose pictures. Using the known rigid spatial relationship of themarkers 225 on the image frame, the position of the object 240 in athree-dimensional space can be determined. The object 240 location canbe continuously output to the display 210. The display 210 can alsocontinuously display the object 240 location relative to the patientanatomy. The known position of the object can serve to register a set ofanatomic landmarks that are understood by the system to define ananatomically based coordinate system. This system can describe anatomicdirections relative to the implant host, such as “left”, “right”,“superior” (up), and “anterior” (to the front). Registration of theselandmarks to an anatomic coordinate system is well understood by thoseskilled in the art of orthopedic surgical navigation. More advancedregistrations, such as registration to preoperatively attainted medicalimages, such as computed tomography or CT, is also evident to thoseskilled in the art.

FIG. 3A is a diagram of a gap planning user interface 300, according toan example embodiment, that can be displayed using the computing system110 (FIG. 1) or 210 (FIG. 2). Through visualization and controls on theuser interface 300, a surgeon can select from two or more options formoving a virtual implant relative to one or more of the subject bones.The surgeon can view in advance the effect that each of the candidateoptions for movement will have on the joint gap at various points in therange of motion of the joint. In this manner, the surgeon canincrementally change implant locations to arrive at an optimized gapcurve.

Before the virtual implant placement described herein, the surgeon ortechnician can have recorded the motion of the leg, for example themotion of the bones of the knee joint, through a range of motion of thejoint. However, embodiments are not limited thereto. The graph depiction334, hereinafter a “gap curve,” can be a replaying of that recordedmotion, but with the virtual implants in place. The graph therefore candepict how the virtual implants interact with each other in thoserecorded positions. For example, a gap curve can show the surgeon howthe gap between the tibia and femur changes with each degree of flexionof the joint. An overlap represents a measure of the degree to which thevirtual implants will cause the tibia and femur to overlap (e.g., a“negative gap”).

The user interface 300 of FIG. 3A depicts gap planning with views of afemoral implant 302. Some embodiments can include a same or at leastsomewhat similar user interface that includes views of a tibia (notshown in 3A), for virtual placement of an implant on the tibia. Eachquadrant 304, 306, 308, and 310 of the display can depict a differentview of the femoral implant 302. FIG. 3B includes an enlarged depictionof a quadrant 304, gap curves 330 and 332, and the graph 334 describedherein regarding FIG. 3A.

These views can be aligned with the anatomic coordinate systems so therelative placements of the implants in these views can be correlated toadjustments in the surgical plan that the surgeon better understands,such as movement of the implant “to the anterior”. The locations of thebone relative to the sensors are mapped by points 312 in the quadrantviews 304, 306, 308, and 310. The locations of a target bone can also beused as inputs to functions described herein. In the illustrativeexample, the upper left quadrant 304 can include four arrows 314, 316,318 and 320. The left (L) and right (R) 316 and 314 can be buttons forvirtually moving the implant anatomically right and left, respectively.The up arrow and down arrow 318 and 320 can be buttons for virtuallymoving the implant superior (S) anatomically to its current position orinferior (I) to its current position, respectively. The upper rightquadrant 306 can depict another view of the femoral implant 302 with acurrent position 312 of the bone relative to the sensors. In addition toinferior and superior movements, the upper right quadrant can providecontrols (not shown in FIG. 3A) for moving the virtual implant in aposterior (P) or anterior (A) direction. Rotation buttons, for examplethe two rotation buttons 322 and 324 shown in the upper left quadrant304, can allow the surgeon to rotate the implants virtually. Zoomingbuttons 326 and 328 can allow the surgeon to zoom the view in or out.

Taken alone, the interface described above allows the surgeon tomanipulate the positions of the implants relative to their host bones.However, it can be difficult for the surgeon to know which direction tomove the implants to result, for example, in a “better” gap curve.Therefore, the system can further evaluate some or all of theadjustments available in the user interface as candidate new positions.The system can then apply (in the example above) a heuristic function tothe data that makes up the gap curve for each candidate parameter, andselect at least two of these adjustments as representing next bestincremental movements of the implant, such as femoral implant 302. In anexample, the user interface 300 can color code the representative gapcurves and the corresponding controls, such as 314, 316, 318, or 320,that the surgeon would manipulate to achieve the new gap curve.

The result of these candidate motions can be depicted as predicted gapcurves 330 and 332 in the graph 334 along the bottom of the exampledisplay. FIG. 3B illustrates an enlarge view of predicted gap curves 330and 332 in the graph 334. The resulting gap curves 330 and 332 can becolor-coded in some embodiments to correspond to their candidate motionsshown in the quadrants 304, 306, 308 and 310. For example, moving theimplant in a superior (S) direction can create a gap curve 330. Movingthe implant in an inferior (I) direction can create a gap curve 332.These allow the surgeon to appreciate quickly the effects of thosecandidate motions that likely affect the gap curve in a preferable way.This allows the surgeon to focus more attention on more qualitativefactors, such as the fit of the implant surface to the native boneshape.

Furthermore, the color-coded Alternative buttons 336 and 338 to theright of the gap curve 334 can allow the surgeon to implement movementsof the virtual implant to create, in one movement, the correspondingcolor-coded gap curve. For example, clicking the alternative button 336can result in the implants being placed to create the gap curve 330. Asurgeon can choose the Alternative buttons 336 or 338 when, for example,the surgeon has decided that the gap curve 330 or 332 is optimal ornearly optimal based on the surgeon's own professional opinion or onother criteria.

Other user interface elements can be provided. A help button 340 can beprovided to provide online guidance to the surgeon. The Femur button 344can be used to select the current model, for example, the button can beused to select planning of the femur or tibial implant. Therefore, theuser interface can be changed to display a tibia for planning of atibial implant. The thickness of the displayed femoral implant 302 canbe changed using buttons 346 or 348. The Tibia menu 350 can be used tochange the thickness of a tibia using buttons 352, 354, 356, and 358.The Add Femur Points button 360 can be used to add more points 312 onthe displayed bone. The Femoral Reference box 362 can display thecurrent femoral reference being used. Pressing the button 364, hereincaptioned “kinematic axis,” can display a menu of other availablefemoral references. The Reset position button 366 can reset the implantposition to the implant position's default position.

The computing system 110, according to example embodiments, can simulateone or all of the surgeon's incremental movements of the virtualimplants to calculate one or more candidate movements for presenting tothe surgeon for subsequent selections. A subsequent set of candidateparameters can then be presented to the surgeon, and the surgeon canview a preview of a second set of gap curves that would result from anyor all of the candidate movements.

The subsequent set of candidate positions can be presented in the sameor different quadrant views, with the same or different candidatecontrol options. For example, a subsequent set of candidate positionsmay not present a superior movement or an anterior movement alternativeto the surgeon, at least potentially indicating that such movementswould place the implant out of tolerances or guidelines. Alternatively,a subsequent set of candidate positions can present a superior movementalternative but not present an inferior movement alternative. Thesurgeon can iteratively select candidate positions, view resulting gapcurves, and be presented with further sets of candidate positions andgap curves, until the surgeon is satisfied with a gap curve.

When the surgeon is satisfied with a gap curve, the surgeon cansurgically implant a femoral implant, a tibial implant, or both afemoral implant and a tibial implant, to create the simulated gap curvein the actual knee joint of the patient. Additionally, when the surgeonis satisfied with the gap curve, a surgical plan for implementation witha semi-active robotic surgical cutting instrument can be developed. Thesurgical plan can include graphical illustrations of at least a portionof the patients anatomy color-coded to indicate what portion of thedepicted anatomy needs to be altered (e.g., cut).

In example embodiments, therefore, a surgeon can be permitted to focuson the desire to move the gap curve in a particular way, and bepresented with computer-analyzed suggestions for incremental candidatemovements that can create such a gap curve more quickly, without givingup his autonomy or decision-making powers and while still allowing thesurgeon to consider other factors not displayable on a plot.

Example embodiments can aid a surgeon faced with the opportunity toperform a number of actions with an implant, for example adjustments tothe position, orientation, size, or other properties or parametersrelevant to the implant. It can be overwhelming to a surgeon tounderstand the complicated interactions of how each movement wouldaffect the gap curve. Example embodiments therefore provide a“betterness function,” to guide the surgeon with implant movements oradjustments.

EXAMPLE METHODS

FIG. 4 is a flowchart illustrating a method 400 for gap planning,according to an example embodiment. In operation 410, the computingsystem 110 (FIG. 1) can receive a first (e.g., initial) implantparameter set. The first implant parameter set can define parameters ofa surgical plan. The surgical plan can be previously generated usingdata collected while moving the joint through a range of motion.However, embodiments are not limited thereto. The joint can be a kneejoint although embodiments are not limited thereto.

The computing system 110 can generate and display an initial gap curvebased on gap data collected while moving the joint through the range ofmotion. The first implant parameter set can include one or more of asize of an implant, a shape of the implant, an orientation of theimplant, and a position of the implant relative to the joint. Thecomputing system 110 can generate and display a virtualthree-dimensional model of the joint for using in the planning process,and the computing system 110 can generate and display an initial implantlocation based at least in part on the virtual three-dimensional modeland on the first implant parameter set.

The target bone model can include a medical image, a point cloud, aparametric model, or other morphological description of the target bone.The medical images can include two-dimensional (2D) or three-dimensional(3D) images. Examples of the medical images include an X-ray, anultrasound image, a computed tomography (CT) scan, a magnetic resonance(MR) image, a positron emission tomography (PET) image, a single-photonemission computed tomography (SPECT) image, or an arthrogram. The targetbone model can include shape data, appearance data, or data representingother morphological characteristics of the target bone surface. Theshape data may include geometric characteristics of a bone such aslandmarks, surfaces, boundaries of 3D images objections. The appearancedata may include both geometric characteristics and intensityinformation of a bone.

In operation 420, the computing system 110 can generate a first set ofcandidate implant parameter sets. An implant parameter set can include,for example, a size of an implant, a shape of the implant, anorientation of the implant, and a position of the implant relative tothe joint. Each candidate parameter set will be the result of anincremental change, relative to the first implant parameter set, to atleast one parameter of the first parameter set. The increments of theseincremental changes can be user-configurable.

In operation 430, the computing system 110 can apply a function to eachof the candidate implant parameter sets of the first set, to calculate aresult of each candidate implant parameter set of the first set ofcandidate implant parameter sets. The result can include a gap curverepresenting a gap between the implant and a contacting surface of thejoint. The gap can be represented at a plurality of points through arange of motion of the joint.

A first example function for executing operation 430 can evaluate thegap at each of the measured flexion positions for a configurationrepresented by the candidate implant parameter set, and perform a sum ofthe magnitudes (i.e. the mathematical “absolute values”) of those gapspacings to determine a “total spacing” result. The first examplefunction can be used to rank the candidate implant parameter sets withrespect to an ideal gap curve, where the ideal gap curve would have zeroor substantially zero positive gap or negative gap (i.e. overlap) of theimplants in any position measured during the range of motion. The idealgap curve with respect to the first example function implies that theimplants are just barely touching, and that the articular motion of thepostoperative joint is very similar to the preoperative joint. The“total spacing” for this parameter set would be zero. Ranking ofparameter sets in this example would consider lower total spacings to bebetter than higher total spacings.

A second example function for executing operation 430 would have aresult that includes the sum of the magnitudes of any positive gaps anddoubled magnitudes of any negative gaps. The second example functionwould prefer positive gaps to negative gaps, thereby preferring a looserjoint to a joint that would be tight due to overlap of the implantsduring the range of motion.

In operation 440, the computing system 110 can provide a graphicalrepresentation of the result according to at least one candidate implantparameter set of the first set of candidate implant parameter sets. Theresult can be provided within a surgical planning graphical userinterface (GUI), and the result can include result identificationinformation. For example, the computing system 110 can apply colors orother visual indicators such that a result can be visually correlated touser-interface elements that will lead to the corresponding result asdescribed herein with respect to FIGS. 3A and 3B. In some embodiments,computing system 110 can implement operation 440 by applying anevaluation function to the first set of candidate implant parameter setsto determine a preferred candidate parameter set, and the computingsystem 110 can then provide, within the surgical planning GUI, agraphical indication corresponding to the preferred candidate parameterset. Embodiments are not limited to only one preferred candidateparameter set and more than one preferred candidate parameter set can beprovided.

In operation 450, the computing system 110 can provide, within thesurgical planning GUI, user interface controls to allow a user toexecute incremental changes corresponding to candidate implant parametersets of the first set of candidate implant parameter sets. Selecting atleast one of the user interface controls implements the result of atleast one candidate implant parameter set in the graphicalrepresentation. At least one of the user interface controls includesidentification information correlating to result identificationinformation for the result of the corresponding candidate implantparameter set.

In operation 460, the computing system 110 can receive a selection of acandidate implant parameter set of the first set of candidate implantparameter sets. The computing system 110 can receive the selection viathe user interface controls. The selection can be based on a gap curveshape criterion as described herein regarding FIGS. 3A and 3B.Subsequent to receiving the selection, the computing system 110 cangenerate another set of one or more candidate implant parameter sets.

Though arranged serially in the example of FIG. 4, other examples canreorder the operations, omit one or more operations, and/or execute twoor more operations in parallel using multiple processors or a singleprocessor organized as two or more virtual machines or sub-processors.Moreover, still other examples can implement the operations as one ormore specific interconnected hardware or integrated circuit modules withrelated control and data signals communicated between and through themodules. Thus, any process flow is applicable to software, firmware,hardware, and hybrid implementations.

Modules, Components and Logic

Certain embodiments of the computer systems described herein can includelogic or a number of components, modules, or mechanisms. Modules canconstitute either software modules (e.g., code embodied on amachine-readable medium or in a transmission signal) or hardwaremodules. A hardware module is a tangible unit capable of performingcertain operations and can be configured or arranged in a certainmanner. In example embodiments, one or more computer systems (e.g., astandalone, client or server computer system) or one or more hardwaremodules of a computer system (e.g., a processor or a group ofprocessors) can be configured by software (e.g., an application orapplication portion) as a hardware module that operates to performcertain operations as described herein.

In various embodiments, a hardware module can be implementedmechanically or electronically. For example, a hardware module cancomprise dedicated circuitry or logic that is permanently configured(e.g., as a special-purpose processor, such as a field programmable gatearray (FPGA) or an application-specific integrated circuit (ASIC)) toperform certain operations. A hardware module can also compriseprogrammable logic or circuitry (e.g., as encompassed within ageneral-purpose processor or other programmable processor) that istemporarily configured by software to perform certain operations. Itwill be appreciated that the decision to implement a hardware modulemechanically, in dedicated and permanently configured circuitry, or intemporarily configured circuitry (e.g., configured by software) can bedriven by cost and time considerations.

Accordingly, the term “hardware module” should be understood toencompass a tangible entity, be that an entity that is physicallyconstructed, permanently configured (e.g., hardwired) or temporarilyconfigured (e.g., programmed) to operate in a certain manner and/or toperform certain operations described herein. Considering embodiments inwhich hardware modules are temporarily configured (e.g., programmed),each of the hardware modules need not be configured or instantiated atany one instance in time. For example, where the hardware modulescomprise a general-purpose processor configured using software, thegeneral-purpose processor can be configured as respective differenthardware modules at different times. Software can accordingly configurea processor, for example, to constitute a particular hardware module atone instance of time and to constitute a different hardware module at adifferent instance of time.

Hardware modules can provide information to, and receive informationfrom, other hardware modules. Accordingly, the described hardwaremodules can be regarded as being communicatively coupled. Where multiplesuch hardware modules exist contemporaneously, communications can beachieved through signal transmission (e.g., over appropriate circuitsand buses) that connect the hardware modules. In embodiments in whichmultiple hardware modules are configured or instantiated at differenttimes, communications between such hardware modules can be achieved, forexample, through the storage and retrieval of information in memorystructures to which the multiple hardware modules have access. Forexample, one hardware module can perform an operation and store theoutput of that operation in a memory device to which it iscommunicatively coupled. A further hardware module can then later accessthe memory device to retrieve and process the stored output. Hardwaremodules can also initiate communications with input or output devices,and can operate on a resource (e.g., a collection of information).

The various operations of example methods described herein can beperformed, at least partially, by one or more processors that aretemporarily configured (e.g., by software) or permanently configured toperform the relevant operations. Whether temporarily or permanentlyconfigured, such processors can constitute processor-implemented modulesthat operate to perform one or more operations or functions. The modulesreferred to herein can, in some example embodiments, compriseprocessor-implemented modules.

Similarly, the methods described herein can be at least partiallyprocessor-implemented. For example, at least some of the operations of amethod can be performed by one or more processors orprocessor-implemented modules. The performance of certain of theoperations can be distributed among the one or more processors, not onlyresiding within a single machine, but also deployed across a number ofmachines. In some example embodiments, the processor or processors canbe located in a single location (e.g., within a home environment, anoffice environment or as a server farm), while in other embodiments theprocessors can be distributed across a number of locations.

The one or more processors can also operate to support performance ofthe relevant operations in a “cloud computing” environment or as a“software as a service” (SaaS). For example, at least some of theoperations can be performed by a group of computers (as examples ofmachines including processors), with these operations being accessiblevia a network (e.g., the Internet) and via one or more appropriateinterfaces (e.g., APIs).

Electronic Apparatus and System

Example embodiments can be implemented in digital electronic circuitry,in computer hardware, firmware, software, or in combinations of them.Example embodiments can be implemented using a computer program product,for example, a computer program tangibly embodied in an informationcarrier, for example, in a machine-readable medium for execution by, orto control the operation of, data processing apparatus, for example, aprogrammable processor, a computer, or multiple computers. Certainexample embodiments of a computing system 110 (FIG. 1) can include amachine-readable medium storing executable instructions to be performedby the computing system 110.

A computer program can be written in any form of programming language,including compiled or interpreted languages, and it can be deployed inany form, including as a stand-alone program or as a module, subroutine,or other unit suitable for use in a computing environment. A computerprogram can be deployed to be executed on one computer or on multiplecomputers at one site or distributed across multiple sites andinterconnected by a communication network.

In example embodiments, operations can be performed by one or moreprogrammable processors executing a computer program to performfunctions by operating on input data and generating output. Methodoperations can also be performed by, and apparatus of exampleembodiments can be implemented as, special purpose logic circuitry(e.g., a FPGA or an ASIC).

The computing system can include clients and servers. A client andserver are generally remote from each other and typically interactthrough a communication network. The relationship of client and serverarises by virtue of computer programs running on the respectivecomputers and having a client-server relationship to each other. Inembodiments deploying a programmable computing system, it will beappreciated that both hardware and software architectures requireconsideration. Specifically, it will be appreciated that the choice ofwhether to implement certain functionality in permanently configuredhardware (e.g., an ASIC), in temporarily configured hardware (e.g., acombination of software and a programmable processor), or a combinationof permanently and temporarily configured hardware can be a designchoice. Below are set out hardware (e.g., machine) and softwarearchitectures that can be deployed, in various example embodiments.

Example Machine Architecture and Machine-Readable Medium

FIG. 5 is a block diagram of machine in the example form of a computersystem 110 within which instructions, for causing the machine to performany one or more of the methodologies discussed herein, can be executed.In alternative embodiments, the machine operates as a standalone deviceor can be connected (e.g., networked) to other machines. In a networkeddeployment, the machine can operate in the capacity of a server or aclient machine in server-client network environment, or as a peermachine in a peer-to-peer (or distributed) network environment. Themachine can be a personal computer (PC), a tablet PC, a set-top box(STB), a PDA, a cellular telephone, a web appliance, a network router,switch or bridge, or any machine capable of executing instructions(sequential or otherwise) that specify actions to be taken by thatmachine. Further, while only a single machine is illustrated, the term“machine” shall also be taken to include any collection of machines thatindividually or jointly execute a set (or multiple sets) of instructionsto perform any one or more of the methodologies discussed herein.

The example computer system 110 includes a processor 502 (e.g., acentral processing unit (CPU), a graphics processing unit (GPU) orboth), a main memory 504 and a static memory 506, which communicate witheach other via a bus 508. The computer system 110 can further include avideo display unit 510 (e.g., a liquid crystal display (LCD) or acathode ray tube (CRT)). The computer system 110 also includes analphanumeric input device 512 (e.g., a keyboard), a user interface (UI)navigation device (or cursor control device) 514 (e.g., a mouse), a diskdrive unit 516, trackers 518 or firmware for reading motion sensors suchas, for example, sensors 120 (FIG. 1) or 220 (FIG. 2) and a networkinterface device 520.

The trackers can sense locations of anatomical structures in an implanthost. The processor 502 can receive a first implant parameter set. Thefirst implant parameter set will define parameters of a surgical plan.The surgical plan will have been generated using data collected whilemoving the joint through a range of motion. Examples of currentlyavailable trackers include optical tracking systems, such as the PolarisSpectra system (available from Northern Digital Incorporated, Ontario,Canada), or the electromagnetic tracking system Aurora (also availablefrom Northern Digital Incorporated.). The Polaris Spectra tracksposition and rotation of infrared-reflective arrays mounted to thepatient's bones and surgical instruments using a stereo-camera videosystem. The Aurora senses position by sensing currents in coils that areattached to the patient and the surgical instruments, while a magneticfield transmitter modulates a magnetic field in proximity to thesensors. Both of these systems, and other similar systems, are currentlyavailable to provide the tracking capability in computer-assistedsurgical systems. These systems can communicate with the computer system110 using protocols such as USB (Universal Serial Bus) protocols.

The processor 502 can generate a first set of candidate implantparameter sets, wherein each candidate parameter set of the first set ofcandidate implant parameter sets is the result of an incremental change,relative to the first implant parameter set, to at least one parameterof the first parameter set. A candidate implant parameter set caninclude one or more of a size of an implant, a shape of the implant, anorientation of the implant, and a position of the implant relative tothe joint

The processor 502 can apply a function, as described regarding operation430 of FIG. 4, to each of the candidate implant parameter sets of thefirst set of candidate implant parameter sets. Through use of thisfunction, the processor 502 can calculate a result of each candidateimplant parameter set of the first set of candidate implant parametersets. The result can include a gap curve representing a gap between theimplant and a contacting surface of the joint as described hereinregarding FIGS. 3A and 3B.

The video display 510 can be arranged to present a graphicalrepresentation of the result according to at least one candidate implantparameter set of the first set of candidate implant parameter sets. Theresult can include result identification information similar to, forexample, color-coding as described regarding FIGS. 3A and 3B.

The video display 510 can present user interface controls to allow auser to execute incremental changes corresponding to candidate implantparameter sets of the first set of candidate implant parameter sets.Selecting at least one of the user interface controls implements theresult of at least one candidate implant parameter set in the graphicalrepresentation. At least one of the user interface controls includesidentification information correlating to result identificationinformation for the result of the corresponding candidate implantparameter set.

The video display 510 can be further arranged to receive a selection ofa candidate implant parameter set. The processor 502 can be arranged toapply an evaluation function to the first set of candidate implantparameter sets to determine a preferred candidate parameter set. Thevideo display 510 can provide a graphical indication corresponding tothe preferred candidate parameter set. The processor 502 can provide asecond set of one or more candidate movements based on the adjustedimplant location.

Machine-Readable Medium

The disk drive unit 516 includes a machine-readable medium 522 on whichis stored one or more sets of instructions and data structures (e.g.,software) 524 embodying or used by any one or more of the methodologiesor functions described herein. The instructions 524 can also reside,completely or at least partially, within the main memory 504, staticmemory 506, and/or within the processor 502 during execution thereof bythe computer system 110, the main memory 504 and the processor 502 alsoconstituting machine-readable media.

While the machine-readable medium 522 is shown in an example embodimentto be a single medium, the term “machine-readable medium” can include asingle medium or multiple media (e.g., a centralized or distributeddatabase, and/or associated caches and servers) that store the one ormore instructions or data structures. The term “machine-readable medium”shall also be taken to include any tangible medium that is capable ofstoring, encoding or carrying instructions for execution by the machineand that cause the machine to perform any one or more of themethodologies of example embodiments, or that is capable of storing,encoding or carrying data structures used by or associated with suchinstructions. The term “machine-readable medium” shall accordingly betaken to include, but not be limited to, solid-state memories, andoptical and magnetic media. Specific examples of machine-readable mediainclude non-volatile memory, including by way of example, semiconductormemory devices (e.g., erasable programmable read-only memory (EPROM),electrically erasable programmable read-only memory (EEPROM), and flashmemory devices; magnetic disks such as internal hard disks and removabledisks; magneto-optical disks; and CD-ROM and DVD-ROM disks. A“machine-readable storage medium” shall also include devices that can beinterpreted as transitory, such as register memory, processor cache, andRAM, among others. The definitions provided herein of machine-readablemedium and machine-readable storage medium are applicable even if themachine-readable medium is further characterized as being“non-transitory.” For example, any addition of “non-transitory,” such asnon-transitory machine-readable storage medium, is intended to continueto encompass register memory, processor cache, and RAM, among othermemory devices.

Transmission Medium

The instructions 524 can further be transmitted or received over acommunications network 526 using a transmission medium. The instructions524 can be transmitted using the network interface device 520 and anyone of a number of well-known transfer protocols (e.g., HTTP). Examplesof communication networks include a LAN, a WAN, the Internet, mobiletelephone networks, plain old telephone (POTS) networks, and wirelessdata networks (e.g., WiFi and WiMax networks). The term “transmissionmedium” shall be taken to include any intangible medium that is capableof storing, encoding, or carrying instructions for execution by themachine, and includes digital or analog communications signals or otherintangible media to facilitate communication of such software.

Although an embodiment has been described with reference to specificexample embodiments, it will be evident that various modifications andchanges can be made to these embodiments. Accordingly, the specificationand drawings are to be regarded in an illustrative rather than arestrictive sense. The accompanying drawings that form a part hereof,show by way of illustration, and not of limitation, specific embodimentsin which the subject matter can be practiced. The embodimentsillustrated are described in sufficient detail to enable those skilledin the art to practice the teachings disclosed herein. Other embodimentscan be used and derived therefrom, such that structural and logicalsubstitutions and changes can be made without departing from the scopeof this disclosure. This Detailed Description, therefore, is not to betaken in a limiting sense, and the scope of various embodiments isdefined only by the appended claims, along with the full range ofequivalents to which such claims are entitled.

Although specific embodiments or examples have been illustrated anddescribed herein, it should be appreciated that any arrangementcalculated to achieve the same purpose can be substituted for thespecific embodiments shown. This disclosure is intended to cover any andall adaptations or variations of various embodiments. Combinations ofthe above embodiments, and other embodiments not specifically describedherein, will be apparent to those of skill in the art upon reviewing theabove description.

All publications, patents, and patent documents referred to in thisdocument are incorporated by reference herein in their entirety, asthough individually incorporated by reference. In the event ofinconsistent usages between this document and those documents soincorporated by reference, the usage in the incorporated reference(s)should be considered supplementary to that of this document; forirreconcilable inconsistencies, the usage in this document controls.

In this document, the terms “a” or “an” are used, as is common in patentdocuments, to include one or more than one, independent of any otherinstances or usages of “at least one” or “one or more.” In thisdocument, the term “or” is used to refer to a nonexclusive or, such that“A or B” includes “A but not B,” “B but not A,” and “A and B,” unlessotherwise indicated. In the appended claims, the terms “including” and“in which” are used as the plain-English equivalents of the respectiveterms “comprising” and “wherein.” Also, in the following claims, theterms “including” and “comprising” are open-ended; that is, a system,device, article, or process that includes elements in addition to thoselisted after such a term in a claim are still deemed to fall within thescope of that claim. Moreover, in the following claims, the terms“first,” “second,” “third,” and so forth are used merely as labels, andare not intended to impose numerical requirements on their objects.

The Abstract of the Disclosure is provided to comply with 37 C.F.R.§1.72(b), requiring an abstract that will allow the reader to quicklyascertain the nature of the technical disclosure. It is submitted withthe understanding that it will not be used to interpret or limit thescope or meaning of the claims. In addition, in the foregoing DetailedDescription, it can be seen that various features are grouped togetherin a single embodiment for streamlining the disclosure. This method ofdisclosure is not to be interpreted as reflecting an intention that theclaimed embodiments require more features than are expressly recited ineach claim. Rather, as the following claims reflect, inventive subjectmatter lies in less than all features of a single disclosed embodiment.Thus, the following claims are hereby incorporated into the DetailedDescription, with each claim standing on its own as a separateembodiment.

1-22. (canceled)
 23. A computer-implemented method for determining aplacement of one or more implants, the method comprising: receiving aninitial parameter set for placing the one or more implants, wherein theinitial parameter set comprises a plurality of parameters; generating aplurality of candidate parameter sets, wherein each of the plurality ofcandidate parameter sets comprises the initial parameter set with achanged value for at least one of the plurality of parameters; for eachcandidate parameter set, determining a result for the candidateparameter set, wherein the result comprises a gap curve at a pluralityof points through a range of motion of a joint according to thecandidate parameter set, wherein the gap curve represents a change in aninteraction between implant components as the joint is moved through therange of motion; causing a display to display a graphical representationof the results for one or more of the plurality of candidate parametersets; receiving a selection of a candidate parameter set from theplurality of candidate parameter sets; and specifying a placement of theone or more implants based on the selected candidate parameter set. 24.The method of claim 23, further comprising: applying an evaluationfunction to each of the plurality of candidate parameter sets todetermine a preferred parameter set; and causing the display to providea graphical indication corresponding to the preferred parameter set. 25.The method of claim 23, wherein the initial parameter set includes oneor more of a size of at least one of the one or more implants, a shapeof at least one of the one or more implants, an orientation of at leastone of the one or more implants, and a position of at least one of theone or more implants relative to the joint or another implant.
 26. Themethod of claim 23, wherein, for each candidate parameter set, the gapcurve further represents a gap between an implant of the one or moreimplants and a contacting surface of the joint for the candidateparameter set.
 27. The method of claim 23, wherein, for each candidateparameter set, the gap curve further represents a gap between a firstimplant of the one or more implants and a second implant of the one ormore implants for the candidate parameter set.
 28. The method of claim23, further comprising: subsequent to receiving the selection of thecandidate parameter set, generating a second plurality of candidateparameter sets, wherein each of the second plurality of candidateparameter sets comprises the selected candidate parameter set with achanged value for at least one of the plurality of parameters.
 29. Themethod of claim 23, further comprising: determining the initialparameter set by moving the joint through a range of motion; generatingan initial gap curve based on the initial parameter set; and causing thedisplay to display the initial gap curve.
 30. The method of claim 23,further comprising: generating a virtual three-dimensional model of thejoint; determining an initial implant location based at least in part onthe virtual three-dimensional model and the initial parameter set; andcausing the display to display the virtual three-dimensional model andthe initial implant location.
 31. The method of claim 23, wherein thejoint is a knee joint.
 32. A system for determining a placement of oneor more implants, the system comprising: a processor; a display inoperable communication with the processor; and a non-transitoryprocessor-readable storage medium in operable communication with theprocessor, wherein the processor-readable storage medium comprises oneor more instructions that, when executed, cause the processor to:receive an initial parameter set for placing the one or more implants,wherein the initial parameter set comprises a plurality of parameters,generate a plurality of candidate parameter sets, wherein each of theplurality of candidate parameter sets comprises the initial parameterset with a changed value for at least one of the plurality ofparameters, for each candidate parameter set, determine a result for thecandidate parameter set, wherein the result comprises a gap curve at aplurality of points through a range of motion of a joint according tothe candidate parameter set, wherein the gap curve represents a changein an interaction between implant components as the joint is movedthrough the range of motion, cause the display to display a graphicalrepresentation of the results for one or more of the plurality ofcandidate parameter sets, receive a selection of a candidate parameterset from the plurality of candidate parameter sets, and specify aplacement of the one or more implants based on the selected candidateparameter set.
 33. The system of claim 32, wherein the one or moreinstructions further cause the processor to: apply an evaluationfunction to each of the plurality of candidate parameter sets todetermine a preferred parameter set; and cause the display to provide agraphical indication corresponding to the preferred parameter set. 34.The system of claim 32, wherein the initial parameter set includes oneor more of a size of at least one of the one or more implants, a shapeof at least one of the one or more implants, an orientation of at leastone of the one or more implants, and a position of at least one of theone or more implants relative to the joint or another implant.
 35. Thesystem of claim 32, wherein, for each candidate parameter set, the gapcurve further represents a gap between an implant of the one or moreimplants and a contacting surface of the joint for the candidateparameter set.
 36. The system of claim 32, wherein, for each candidateparameter set, the gap curve further represents a gap between a firstimplant of the one or more implants and a second implant of the one ormore implants for the candidate parameter set.
 37. The system of claim32, wherein the one or more instructions further cause the processor to:subsequent to receiving the selection of the candidate parameter set,generate a second plurality of candidate parameter sets, wherein each ofthe second plurality of candidate parameter sets comprises the selectedcandidate parameter set with a changed value for at least one of theplurality of parameters.
 38. The system of claim 32, wherein the one ormore instructions further cause the processor to: determine the initialparameter set by moving the joint through a range of motion; generate aninitial gap curve based on the initial parameter set; and cause thedisplay to display the initial gap curve.
 39. The system of claim 32,wherein the one or more instructions further cause the processor to:generate a virtual three-dimensional model of the joint; determine aninitial implant location based at least in part on the virtualthree-dimensional model and the initial parameter set; and cause thedisplay to display the virtual three-dimensional model and the initialimplant location.
 40. A non-transitory processor-readable storage mediumcomprising one or more instructions that, when executed, cause aprocessor to: receive an initial parameter set for placing the one ormore implants, wherein the initial parameter set comprises a pluralityof parameters; generate a plurality of candidate parameter sets, whereineach of the plurality of candidate parameter sets comprises the initialparameter set with a changed value for at least one of the plurality ofparameters; for each candidate parameter set, determine a result for thecandidate parameter set, wherein the result comprises a gap curve at aplurality of points through a range of motion of a joint according tothe candidate parameter set, wherein the gap curve represents a changein an interaction between implant components as the joint is movedthrough the range of motion; cause a display to display a graphicalrepresentation of the results for one or more of the plurality ofcandidate parameter sets; receive a selection of a candidate parameterset from the plurality of candidate parameter sets; and specify aplacement of the one or more implants based on the selected candidateparameter set.
 41. The storage medium of claim 40, wherein the one ormore instructions further cause the processor to: apply an evaluationfunction to each of the plurality of candidate parameter sets todetermine a preferred parameter set; and cause the display to provide agraphical indication corresponding to the preferred parameter set. 42.The storage medium of claim 40, wherein the one or more instructionsfurther cause the processor to: subsequent to receiving the selection ofthe candidate parameter set, generate a second plurality of candidateparameter sets, wherein each of the second plurality of candidateparameter sets comprises the selected candidate parameter set with achanged value for at least one of the plurality of parameters.
 43. Thestorage medium of claim 40, wherein the one or more instructions furthercause the processor to: determine the initial parameter set by movingthe joint through a range of motion; generate an initial gap curve basedon the initial parameter set; and cause the display to display theinitial gap curve.
 44. The storage medium of claim 40, wherein the oneor more instructions further cause the processor to: generate a virtualthree-dimensional model of the joint; determine an initial implantlocation based at least in part on the virtual three-dimensional modeland the initial parameter set; and cause the display to display thevirtual three-dimensional model and the initial implant location.